🚧 Under construction — VoTechWorks is being built. A free tech program — complimentary, as our commitment to get America working.
voTechWorksGrade 13 · a vocational technology learning center, by urbanicity
newSchoolWorks.com › VoTechWorks › Agriculture, Environment & Public Service › Firefighting / Public Safety › Emergency Medical Technician – Basic (EMT-B) › Lesson 3
AGR-FIRE51-06 · Lesson 3 · 14 clock hours · lab

Airway Management and Ventilation

Objective. Students will perform a complete sequence of airway management skills — positioning, suctioning, OPA/NPA insertion, BVM ventilation with oxygen, and pulse oximetry interpretation — on manikins at NREMT psychomotor skill-sheet standards.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed professional in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it as instructions for work on a job site or on live equipment. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Airway Management and Ventilation

Airway management is the single most critical skill an EMT performs. A patient who cannot maintain a patent airway will suffer brain injury or death within minutes. Every step in this lab — positioning, suctioning, adjunct insertion, and ventilation — builds toward one goal: delivering adequate oxygen to the patient's tissues and removing carbon dioxide.

Why the Airway Fails

In an unresponsive patient, muscle tone in the tongue and soft palate collapses, blocking the pharynx. Vomit, blood, secretions, or a foreign body can compound the obstruction. Your first task is always to open the airway manually, then clear it, then maintain it with an adjunct if needed.

Manual Positioning

Head-tilt/chin-lift is the standard technique for any patient without suspected spinal injury. Place one hand on the forehead and tilt the head back; place the fingertips of your other hand under the bony part of the chin and lift. Avoid pressing on soft tissue, which can compress the airway.

Jaw-thrust is used when you suspect a cervical spine injury. Place your fingers behind the angles of the mandible and push the jaw forward without tilting the head. This technique is harder to maintain and requires practice to master.

Safety note: If the jaw-thrust does not open the airway in a patient who is not breathing, the standard of care allows you to perform a head-tilt/chin-lift — an open airway takes priority over spinal precaution alone.

Suctioning

Suction any visible liquid material before inserting an adjunct or attempting ventilation. Use a rigid (Yankauer) catheter for the oropharynx and a soft catheter for the nasopharynx or through an adjunct. Insert the catheter with suction off (or with a thumb port open), apply suction only while withdrawing, and limit each suction attempt to no more than 15 seconds for an adult (shorter for pediatric patients). Re-oxygenate between attempts. Suction units — both manual and powered — must be checked before every response.

Oropharyngeal Airway (OPA)

The OPA prevents the tongue from occluding the pharynx. It is used only in patients who are unresponsive and have no gag reflex. Measure from the corner of the mouth to the earlobe (or from the center of the mouth to the angle of the jaw). For adults, insert it upside-down and rotate 180° as it passes the soft palate, or use a tongue-blade technique and insert it right-side up. Re-assess breath sounds and chest rise after insertion.

Critical failure: Inserting an OPA in a patient who has a gag reflex can cause vomiting and aspiration.

Nasopharyngeal Airway (NPA)

The NPA is tolerated by patients who are semiconscious or who have a gag reflex but still need airway support. Contraindications include significant facial or head trauma (use with caution). Measure from the tip of the nose to the earlobe. Lubricate the NPA generously before insertion. Insert it bevel toward the nasal septum, directing it straight back (not upward), following the floor of the nasal cavity. If resistance is felt, try the other nostril.

Bag-Valve-Mask (BVM) Ventilation

The BVM delivers positive-pressure ventilation. Connect it to oxygen at the flow rate appropriate to fill the reservoir bag fully. For one-person BVM, form a C-E clamp with one hand — thumb and index finger form the "C" over the mask, and the remaining three fingers (the "E") grip the mandible — while squeezing the bag with the other hand. For two-person BVM, one provider maintains a two-hand mask seal while the second squeezes the bag.

Deliver each breath over approximately 1 second, just enough to produce visible chest rise. Over-ventilation causes gastric inflation and reduced cardiac output. Ventilate an adult at 10–12 breaths per minute (one breath every 5–6 seconds) for a patient with a pulse. For CPR, follow current AHA guidelines for timing with compressions.

Always confirm effectiveness by watching for bilateral chest rise, listening for breath sounds at the lateral lung bases, and monitoring pulse oximetry.

Pulse Oximetry

A pulse oximeter measures the percentage of hemoglobin saturated with oxygen (SpO₂) using infrared light through a perfused tissue bed (usually a fingertip). Normal SpO₂ is 94–100% at sea level. Readings below 94% indicate the need for supplemental oxygen; readings below 90% indicate significant hypoxia. Limitations include poor peripheral perfusion, nail polish, carbon monoxide poisoning (falsely normal reading), and patient movement. Always correlate the SpO₂ reading with the patient's clinical appearance.

Oxygen Delivery Device Selection

Lab Safety Reminders

Key terms9

Patent airwayAn airway that is open and unobstructed, allowing air to move freely between the environment and the lungs.
Jaw-thrust maneuverA manual airway-opening technique that lifts the mandible forward without extending the cervical spine; preferred when spinal injury is suspected.
Oropharyngeal airway (OPA)A curved rigid adjunct inserted through the mouth to hold the tongue away from the posterior pharynx; used only in patients without a gag reflex.
Nasopharyngeal airway (NPA)A soft, flexible tube inserted through a nostril to maintain a passage between the nares and the pharynx; tolerated by patients who have a gag reflex.
Bag-valve-mask (BVM)A self-inflating ventilation device consisting of a face mask, one-way valve, and compressible bag; used to deliver positive-pressure ventilation with or without supplemental oxygen.
SpO₂The percentage of hemoglobin molecules in arterial blood that are bound to oxygen, as measured non-invasively by a pulse oximeter.
Non-rebreather mask (NRB)An oxygen delivery mask with a one-way valve and reservoir bag that delivers a high concentration of oxygen to patients who are breathing spontaneously.
Gastric distensionInflation of the stomach with air caused by excessive ventilation pressure or volume; increases the risk of regurgitation and aspiration.
C-E clamp techniqueA one-handed BVM mask seal method in which the thumb and index finger press the mask down ("C") while the remaining fingers lift the jaw upward ("E").

Worked examples4

1. You have an adult NRB mask connected to an oxygen cylinder. The regulator gauge reads 1,800 psi and the flow is set to 12 L/min. The reservoir bag is partially collapsed on each breath. What adjustment should you make, and why?
  1. Step 1 – Identify the problem: the reservoir bag must be fully inflated before the patient inhales so the patient receives a high oxygen concentration. A collapsing or partially deflated bag means flow rate may be too low.
  2. Step 2 – Adjust the flow: increase the oxygen flow rate — typically to 12–15 L/min — until the reservoir bag remains at least two-thirds full even during the patient's peak inspiratory effort.
  3. Step 3 – Confirm correction: watch the reservoir bag through several of the patient's breathing cycles to ensure it no longer collapses fully.
Answer: Increase the oxygen flow rate to 15 L/min (or the upper end of the device's recommended range) until the reservoir bag stays adequately inflated throughout the respiratory cycle, ensuring high-concentration oxygen delivery.
2. You are performing one-person BVM ventilation on an adult manikin. Your target is one breath every 5–6 seconds. Over a 30-second period, how many ventilations should you deliver, and what is the resulting rate per minute?
  1. Step 1 – Determine breaths per interval: if one breath is delivered every 5 seconds, in 30 seconds you deliver 30 ÷ 5 = 6 breaths. If one breath is delivered every 6 seconds, in 30 seconds you deliver 30 ÷ 6 = 5 breaths.
  2. Step 2 – Extrapolate to one minute: 6 breaths per 30 seconds × 2 = 12 breaths/min; 5 breaths per 30 seconds × 2 = 10 breaths/min.
  3. Step 3 – Confirm range: 10–12 breaths/min falls within the recommended adult ventilation rate for a patient with a pulse.
Answer: Deliver 5–6 ventilations in 30 seconds, producing a rate of 10–12 breaths per minute — the correct adult ventilation rate for a patient who has a pulse.
3. You size an OPA for an adult patient by measuring from the corner of the mouth to the earlobe and select a size 90 mm airway. When you insert it, the patient gags and begins to retch. What are the correct immediate actions?
  1. Step 1 – Remove the OPA immediately: a gag reflex indicates the patient is not deeply enough unresponsive for an OPA; leaving it in place risks vomiting and aspiration.
  2. Step 2 – Position and protect the airway: turn the patient (or log-roll if spinal injury is suspected) to allow drainage, and prepare suction.
  3. Step 3 – Select an alternative adjunct: consider an NPA of appropriate size if the patient still needs airway support, provided there are no contraindications.
  4. Step 4 – Reassess: after the airway is secure, reassess breath sounds, SpO₂, and mental status.
Answer: Remove the OPA at once to prevent aspiration, position the patient and suction as needed, then reassess and consider an NPA if continued airway support is required.
4. A pulse oximeter reads 88% SpO₂ on a patient who is breathing at 8 slow, shallow breaths per minute. You apply a nasal cannula at 4 L/min. After 2 minutes the SpO₂ is 89%. Is this adequate? What should you do next?
  1. Step 1 – Evaluate the SpO₂ trend: 89% remains below the generally accepted threshold of 94% and represents significant hypoxia; minimal improvement with a nasal cannula is inadequate.
  2. Step 2 – Evaluate the respiratory effort: 8 shallow breaths per minute is inadequate ventilation — the patient is not moving enough air volume regardless of the oxygen device applied.
  3. Step 3 – Upgrade the intervention: this patient requires assisted ventilation with a BVM connected to oxygen, not merely supplemental oxygen via cannula.
Answer: No — 89% SpO₂ with a slow, shallow respiratory rate indicates inadequate ventilation. Remove the nasal cannula, begin BVM ventilation with oxygen, and reassess SpO₂ and chest rise.
In class: Station rotation (four stations): head-tilt/chin-lift and jaw-thrust positioning, oropharyngeal airway sizing and insertion, nasopharyngeal airway sizing and insertion, and suction catheter use on an airway trainer manikin; students repeat each station until consistently correct. · BVM practice: partners alternate performing one-person and two-person BVM ventilation on an adult, child, and infant manikin, measuring mask seal and chest rise; instructor records rate and tidal volume feedback where equipment allows. · Oxygen delivery device selection drill: instructor calls out a simulated SpO2 reading and patient condition; students select and apply the correct device (nasal cannula, non-rebreather mask, BVM) and state the liter-flow setting within 30 seconds.
Materials: Airway management manikins (adult, child, infant), BVM devices (adult/pedi), OPA sets, NPA sets with lubricant, suction units (manual and powered), oxygen cylinders with regulators, non-rebreather masks, nasal cannulas, pulse oximeters, NREMT airway skill sheets
Check: NREMT-format psychomotor skill sheet for BVM ventilation: student must pass all critical criteria (no critical failures) and score 70% on non-critical steps; instructor signs off on OPA and NPA insertion separately with zero critical failures.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Airway, Respiration, and Ventilation
1. You arrive at a scene and find an unresponsive adult with no suspected spinal injury. The first manual technique you should use to open the airway is:
Airway, Respiration, and Ventilation
2. Which of the following is an absolute contraindication for inserting an oropharyngeal airway?
Airway, Respiration, and Ventilation
3. When measuring for a nasopharyngeal airway, the correct landmark measurement is from the:
Airway, Respiration, and Ventilation
4. During BVM ventilation of an adult patient with a pulse, you should deliver ventilations at a rate of approximately:
Airway, Respiration, and Ventilation
5. A patient is breathing spontaneously but has an SpO₂ of 82% and moderate respiratory distress. Which oxygen delivery device is most appropriate?
Airway, Respiration, and Ventilation
6. During one-person BVM ventilation, you notice the manikin's chest is not rising. After repositioning the head and confirming an adequate mask seal, you squeeze the bag again with the same result. The most likely next step is to:
Airway, Respiration, and Ventilation
7. A pulse oximeter reads 99% SpO₂ on a patient you suspect has been exposed to carbon monoxide. You should:
Airway, Respiration, and Ventilation
8. While performing suction on an adult patient, the maximum recommended duration of a single suction attempt is:
Record this lesson on my transcript. Sign in with your key and enrollment email to record lessons (enroll free if you have no key). This page stays open to read and practise.
← Previous lessonProgram planNext lesson →